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Video: Why training needs to be paired with change management

We continue our recap of HTN Now November with a look back at Ideal Health’s live webcast on why digital training needs to go-hand-in-hand with a change management programme.

The presentation – which focused on how best to achieve good digital adoption – was given by the Ideal Health team – Gaelle Fertil, Change Practice Director and Martin Smith, Change and Operational Readiness Lead.

Starting off the session, Gaelle explained that most digital health programmes – be they large or small – usually include, and have resource for, some form of training. “These days,” she added, “we also find that there is a certain amount of effort being made to manage change – there are some people being nominated as change leads, or change management workstreams, so usually there is a little bit of change management as well.”

However, she noted that, “what we do find is that it’s often not enough – training is one of the many tools that you should be adopting, as part of your learning and adoption programme. It should be complemented by some strong change management.”

Gaelle then covered some of the challenges that digital healthcare training can present for the NHS – including the lack of availability for face-to-face training rooms, “with many trusts going for a bit of a hybrid [approach]” due to strain on space and resourcing of staff for ‘just in time’ training.

She also described releasing professionals from clinical duties as “an enormous challenge”, alongside the logistical issues around booking in potentially thousands of people. “They just don’t have the time, either physically or mentally, to be released,” she said, also noting concerns around knowledge retention from one-day training far removed from go-live.

“Finally,” Gaelle said, “a lack of context or relevance to clinical or operational roles means that it is difficult for staff to relate to the content…what we are proposing, to really see high levels of adoption, [is that] we need more than just a training programme,” she added.

Focusing next on Ideal’s idea of the ‘five levels of good learning and adoption’, Gaelle began by picking out level one – classroom training – acknowledging that, despite drawbacks relating to staff time, this form of training does provide benefits by taking people out of their day-to-day to focus on learning alongside peers.

Level two – classroom training with e-learning – “allows trusts to look at how they can modularise” some of the content and remove the need to attend, she said, “so that staff can further their learning…repeat content…refresh learning”, and noted that Ideal is finding that e-learning has advanced to include features such as simulation and gamification, thereby providing greater clinical context.

The next level up typically includes classroom and e-learning training with some form of change management aspect, which Gaelle describes as “really the basics” of what many trusts provide – communications to make staff aware of the changes ahead, explain the vision behind the drive for change, and help them to understand how it can benefit them. “Really good communication can support a successful delivery and make sure people arrive at training ready for it,” she commented.

Level four moves the change management scope wider than just communications, Gaelle added, by using tools such as a change network, which she says, “can be used to gather and share information about the change”, acting as two-way communication to find out about people’s concerns and areas of resistance, and how to contextualise the changes specific to each department.

“You can use a lot of mechanisms to assess a state of readiness – surveys, focus groups, or the change network itself,” she suggested, allowing for trusts to then address any issues and “create a more agile programme to mitigate the risks associated with change” and ensure the project is on the right track.

“Agility and the ability to tailor it is key,” stated Gaelle, before moving on to the ideal, final level five, which adds operational ownership to change management, communications, e-learning, and classroom training. “That’s really where we witness an excellent leader or set of sponsors at every level of the organisation, starting from the top, and really driving that cultural change…and ensuring everyone is aware…that leadership is really what’s going to make an organisation achieve those good levels of adoption,” she said.

“Staff will know the changes are coming, they’ll feel prepared, they’ll feel supported by their management and be able to go to their management with those questions,” Gaelle added.

Martin then returned to the session to go into further detail about the change management activities that trusts can undertake – and how these can be delivered and measured.

“Training is a pivotal part of being able to drive adoption…that’s really what drives the ability to realise benefits, whether that’s related to patient safety, patient experience, staff effectiveness, staff engagement, and obviously the financial elements which do need to be covered to make sure that the investment in the EPR [Electronic Patient Record] is paying for itself over time,” he said.

Focusing on the ADKAR model for change, Martin added: “That is a methodology, or a phased approach for driving change, which was hit upon by the Prosci organisation both Gaelle and I [are part of], we’re both Prosci practitioners and when we were working on EPR implementations, both in the UK and overseas, this was done independently…we both were following this kind of approach and it was shown to have significant benefits in being able to take people and organisations on a journey of awareness, to desire, to knowledge and ability in reinforcing that change.”

Martin then outlined what could be achieved through each of those five stages of awareness, desire, knowledge, ability, and reinforcement. Deliverables around awareness included vision articulation, awareness videos, branding and a PR approach, the impact of which could be measured by a survey.

In terms of driving desire, the focus was on people understanding how workflows are going to change and “giving people a sense of how things are going to be different in the future” through user stories and demonstrations, as well as visualisation, which could also be tracked through an awareness and readiness survey.

On how to deliver knowledge, Martin referred back to Gaelle’s mention of the advances in e-learning, so that organisations are providing the “most flexible, most effective method”, with opportunities for peer-to-peer training and learning guides, and ideas for measurement including simulation assessment, superuser feedback and quizzes.

This then led on to ‘ability’, or offering people the opportunity to practice or “get opportunities to use simulation labs” and “use the system” to make sure people can adapt their learnings for actual use, to avoid gaps between training and go-live.

Finally, reinforcement, Martin illustrated, could be achieved by means such as user generated content, coaching and change bulletins.

“This represents kind of the whole continuum of change management, from the very inception of the programme, and it does require significant input from a wide range of people – both within the programme and leaders, as well as operational managers and teams,” he noted, adding that having a good change management programme would be key.

Switching over to Ideal’s approach to change management, Martin highlighted seven ‘key drivers’ – organisational readiness, sponsorship and leadership, learning and education, benefits planning, communications and engagement, change capability, and measurement and continuous improvement.

“The evidence suggests that actively visible sponsorship and leadership is the number one determinant of change, so making sure you’ve got that in place really helps,” he suggested.

On measurement and improvement, he said: “Taking all of these activities together and making sure that we’re really understanding the impact that we are having – is it actually working? Is our comms message actually landing? Or have people got an understanding of what’s coming and how it’s going to affect them? [It] really does help you identify pockets or areas where there are opportunities to improve, and what you may want to improve.”

He also recommended points such as having clear branding and understanding what is expected and how things will change.

In terms of training, he highlighted Ideal’s ‘inspire’ know-how, including the need for multi-organisational experience, domain management, collaboration – including flexible team structures – as well as effective engagement with both operational and clinical teams, maintaining best practice and industry standards. Also noted were expertise across all EPR elements and systems, and a legacy of knowledge transfer promotion, long-term behaviour change and ongoing benefits realisation, as well as Ideal’s offering of access to training tools such as the automated scheduling software Quantify, which can reduce costs and streamline delivery.

Last but not least, Martin shared Ideal’s transformation plan to showcase how all the steps and areas of the programme are linked and can be mapped out from implementation to go-live and beyond.

“Each of these work streams, important as they are in and of themselves, are far more effective if they are done in concert with one another and being able to identify what’s being done in different phases enables this to be tracked…it really does make sure you have everything that you need from a change management perspective, to give training the best chance of succeeding and making sure you go live successfully and, beyond that, drive the levels of adoption that you are looking for,” he said.

Martin then concluded with a few words about Ideal, sharing that the digital transformation company has worked with 150 NHS organisations and on over 50 major EPR deployments, including supporting business cases, implementation, go-live, training and adoption support.

Click on the video below to see the full session: